Enuresis is a common childhood condition which is usually treatable. Enuresis at any age can lead to embarrassment. This coupled with teasing by peers resulting in social withdrawal, avoidance of overnight stay at relatives, and friends can have a long term effect in relationships than the enuresis itself. Organic and psychological causes should be considered, especially with the late onset or exacerbation of existing enuresis. Principles of management should be focused to address any precipitating and maintaining factors and also provide appropriate advice and explanation.

A 42-year old female reported atraumatic painful swelling in her left ankle and heel since one month. X-ray showed an expansile lytic lesion with thinning of cortex at the anterior end of the left calcaneum. Curettage of the lesion was done and cavity packed with composite bone graft. Postoperative period was uneventful, and patient was ambulatory without aid. Histopathology report showed intraosseous schwannoma. Intraosseous schwannoma is a very rare tumor accounting for only 0.2% of all primary bone tumors. This is the second case of intraosseous schwannoma of calcaneum reported as per literature.

Microfilariaemia presenting with subcutaneous nodule is rare. We report a case of a 22-year-old female patient who presented with a subcutaneous nodule on right forearm. Fine-needle aspiration cytology from the nodule showed many sheathed motile microfilaria on wet mount preparation during day time. Wuchereria loa loa is known to be associated with soft tissue swellings as reported earlier. Nocturnal motility and cytomorphological features differentiate Wuchereria bancrofti from Wuchereria loa loa.

Heterotropic bone formation or intraocular osseous metaplasia is a rare finding. Trauma, chronic inflammation, and long-standing retinal detachment are some of the common etiological factors associated with the onset of intraocular ossification. We report a case of a 16-year-old girl with a history of blunt trauma 6 years back, who complained of right eye blindness. Right eye enucleation was done which on histopathological examination revealed pre-retinal lamellar bone with fatty marrow. We diagnosed her case as intraocular ossification in phthisis bulbi.

Context: The community incidence of acute bacterial meningitis in India is not known. There is a need for a periodic review of bacterial meningitis worldwide, since the pathogens responsible for the infection vary with time, geography, and patient age. Aims: To study some epidemiological factors of acute meningitis. Setting and Design: Hospital based cross sectional study. Materials and Methods: Detailed clinical examination of all clinically suspected cases of meningitis was done. Blood and cerebro spinal fluid culture was done. Statistical Analysis Used: Fisher exact test, P < 0.05 was considered as statistically significant. Results: There were 79 suspected cases of meningitis, majority of cases (74.7%) were under-fives. The case fatality rate (CFR) was 13.9% with a confidence interval ranging from 5.9 to 21.5%. The association between the age and the mortality was not statistically significant. (Fisher's exact test, P = 1). The association between the gender and the mortality was not statistically significant (Fisher's exact test, P = 0.3). Based on the culture examination there were 16 cases of confirmed bacterial meningitis. Commonest isolate was Klebsiella pneumoniae as seen in five cases (31.2%). Neisseria meningitides, H influenzae, or Streptococcus pneumoniae were not isolated in any case. Conclusion: Acute bacterial meningitis is still an important public health problem with a high case fatality rate.

Nasofrontal masses belong to the group of congenital midface anomalies (CMFA) in paediatric age group. Nasofrontal dermoids with patent dermal sinus tract is a rare anomaly resulting from the failure of normal embryogenic process. Most patients present in infancy or early childhood. CT and MRI together are usually required for definitive diagnosis. CT imaging provides vital information about the osseous involvement while MRI is crucial for evaluation of the intracranial extent and detailed tissue characterization. Knowledge of embryonic development is important in understanding the pathologies of nasofrontal masses in paediatric age group.

Gastrointestinal stromal tumors (GISTs) are a rare group of non-epithelial tumors of the gastrointestinal tract and represent less than 1% of all primary gastric tumors. This case report is of a 45-year-old female patient who presented with a lump in the right lower abdomen extending inferiorly into the pelvis. Clinical and radiological findings were suggestive of a large intraperitoneal pelvic mesenchymal tumor or a pedunculated uterine leiomyoma. At laparotomy, the tumor was found arising from lesser curvature of stomach. Complete excision was done and immunohistochemistry confirmed the diagnosis of a GIST. The patient is presently asymptomatic at 4 years and is being kept under surveillance. Gastric GISTs should be locally excised with macroscopically clear margins, allowing subsequent symptomatic follow up without the need for adjuvant therapy, which may be reserved for recurrences if further surgery is deemed inappropriate.

Meckel's diverticulum is congenital abnormality of gastrointestinal tract. It is generally accepted that the radiological demonstration of a Meckel's diverticulum is not practicable. But when there is associated complications with Meckel's diverticulum it becomes relatively easy. Abdominal radiograph does not provide any information but USG and CT features are helpful in diagnosing however the single most accurate diagnostic test for a Meckel's diverticulum is scintigraphy.

Verrucous hemangioma is an uncommon vascular malformation commonly seen in the lower limbs, histologically characterized by vascular proliferation and dilatation from dermis to subcutaneous tissue and proliferative reaction of the epidermis. Here we report a rare case of large verrucous hemangioma on the scalp which was excised and grafted. In a 6-month follow-up, the patient had no recurrence.

Pleomorphic adenomas are slow growing, well-demarcated benign neoplasms that constitute more than 80% of benign parotid tumours. Deep lobe parotid pleomorphic adenomas are rare tumors that present a diagnostic and therapeutic challenge. Approximately 10-12% of pleomorphic adenomas of the parotid are thought to arise from the deep lobe of parotid. Due to anatomical relations and restrictive boundaries of the deep lobe, parapharyngeal extensions may remain asymptomatic until reaching a very large size. These tumors have a variety of distinct clinical presentations, most commonly arising from the portion of the gland deep to the facial nerve lateral to the mandible. We present a case of deep lobe parotid gland pleomorphic adenoma involving the parapharyngeal space in a 38 year old female.

A primary pancreatic-isolated hydatid cyst, that too in tail of pancreas with no lesion in liver, is a rare presentation of this disease. We report a case of 30-year-old lady presenting with only abdominal pain and on imaging found to be a cystic lesion in tail of pancreas without any liver lesion. Contrast-enhanced computed tomography scan is helpful in diagnosis by identifying the presence of multiloculation, curvilinear calcification, or the presence of daughter cysts. She was successfully treated by distal pancreatectomy without splenectomy.

A 60-year-old male patient reported to eye Outpatient Department with the complaint of sudden painless diminution of vision in right eye of 10 h duration. We found a Cherry red spot in the macula and a pale white posterior pole of the retina. Parameters of investigations showed hypertension, ischemic heart disease, and the presence of a carotid plaque in the Doppler study. Paracentesis was done with a 30-Gauge needle immediately within 15 min of the patient reporting to the Eye OPD. Any delay in reporting or institution of treatment can lead to irreversible blindness.

Intraoral lipoma is a benign tumor composed of mature adipocytes. Lipoma in maxillofacial region has a less frequent occurrence, with presentation in the retromolar region being even rarer. Here, we present a case of intraoral lipoma in the retromolar region in a 40-year-old female patient with review.

Background: Traditionally, a laparotomy wound is closed in layers co-opting the various layers anatomically. A new method of closure, namely single layer closure technique (mass closure technique) has come into vogue. Aims: This study aims to evaluate the benefits or otherwise between single layer closure and layered closure after comparing it with studies available in literature. Settings and Design: This study was performed in a teaching institute in patients undergoing laparotomy, either planned or emergency. Materials and Methods: A total of 80 cases were selected at random and the study was carried out over a period of 2 years. The cases were equally divided into two groups of 40. In both groups, vertical midline incision was used. In the first group, abdomen was closed using the single layer closure technique. Continuous suturing with burial of the knots was done in 20 patients and interrupted mass closure was done in another 20 patients. In the other group, the abdomen was closed in layers. The patients were followed up for minimum 6 months. Patients who did not turn up for follow up were asked to notify the development of any wound complication through postal correspondence. Results: The time required for closure was considerably less when continuous suture technique was used. One patient in the mass closure group and four in the layered group developed post-operative wound infections. One patient in the layered closure group developed a stitch sinus. There were two cases of burst abdomen with the layered closure technique. Two patients in the layered closure group developed incisional hernias 6 months post-operatively. Conclusions: Single layer closure technique offers certain definite advantage over the layered closure technique with respect to the time required for closure of the incision, incidence of wound dehiscence and the incidence of incisional hernia. However, the true incidence of wound dehiscence (burst abdomen) and incisional hernia cannot be drawn since the study was of short duration and the number of cases was small without a long follow up.

Aim: To evaluate the utility of bronchoalveolar lavage (BAL) by flexible fiberoptic bronchoscopy (FOB) in sputum smear negative patients with clinical and radiological characteristics of pulmonary tuberculosis (PTB). Materials and Methods: This prospective study was carried out in 30 sputum smear negative patients of age group 20 to 70 years, who were highly suspicious for PTB by clinical and radiographic criteria. All patients were subjected to sputum culture, BAL stains and cultures, and cytopathology. Patients with moderate to massive pleural effusion, obvious accessible lymph node, history of antitubercular therapy (ATT), and contraindication to FOB were excluded. Results: Sputum culture for acid fast bacilli (AFB) was positive in four (12%) patients, BAL fluid was positive for Ziehl-Neelsen (ZN) stain in nine (27%) patients, including four sputum culture patients, while BAL culture for AFB on Lowenstein-Jensen (LJ) medium was positive in 18 (60%), including 9 BAL fluid ZN stain positive patients. Six (20%) patients had growth on pyogenic culture, while two (7%) patients had malignant cell on cytological examination of BAL fluid. Remaining four (13%) patients were empirically started on ATT. They had complete response to ATT at 2 months and were retrospectively diagnosed with pulmonary tuberculosis (PTB). All the bacteriologically confirmed PTB patients were given ATT for 6 months and all patients had complete response. Conclusion: We concluded that FOB guided BAL is extremely useful for establishing diagnosis of PTB or other pulmonary diseases in sputum smear negative patients, who have high suspicion for PTB by clinical and radiographic criteria.

Animations in medical education: You can do it!Manvikar Purushottam RaoJanuary-June 2012, 5(1):18-22DOI:10.4103/0975-2870.97502

Introduction: Animations are the best suited to convey and create an impact of an idea or concept in media business. Animations are sequential frames of pictures shown across this fourth dimension, namely "time." Cartoons are the best examples of animations; needless to say, animations grab the attentions of every one. Animations can also be effectively used in medical education especially in teaching human embryology. It communicates of a concept of three-dimensional structures against one more dimension, namely time. However, to create a module of animation, knowledge, and operative skills of animation software like Flash® , Author ware® , Macromedia® or other high-ended software is necessary. Aim: To design simple, user-friendly and easy to make an effective animation using one of the office tools of Windows® , Power Point® . Materials and Methods: A personal computer with following configuration was used. Pentium III processor with 1.3 Gz speed, 40 GB HDD, 128 MB RAM, with multimedia kit, key pad, and scroll mouse was used. Programs used were Power Point® and MS Paint® . A screen play of sequences of diagrams was written. Frames consisting of diagrams of stages of development were drawn in MS Paint® , and were pasted in PowerPoint slides and animation tool was applied. Previewing was done at every stage. Results: Stages of development of storyboard have been shown as print screen images, 1-6. Conclusion: Emphasis is that such simple animations can be easily made. It is cheap and does not require any sophisticated software. However, it is time consuming but can be taken up as phased assignments or can be given as undergraduate student projects. This will certainly help to build teaching material in the department.

Introduction: Since the pioneering days of the anterior cervical approach introduced by Cloward et al. in the early 1950s, anterior cervical discectomy and fusion (ACDF) has been the standard procedure for most discogenic and degenerative cervical spinal lesions. Although traditional interbody fusion using iliac bone can maintain the patency of the neuroforamen and ensure solid fusion, selection of patients, and of surgical procedure for ACDF is a continuous challenge. Aim: The aim of this study was to assess the results of cervical discectomy and fusion with cervical cages in treatment of cervical radiculopathy clinically and radiologically. Materials and Methods: Eighteen patients suffering from cervical radiculopathy were operated upon using this technique. They were 15 males and 3 females. Clinical and radiological assessment, visual analog scale (VAS) for neck and arm and modified Oswestery neck disability index (NDI) were done preoperatively and at 4 weeks, 3, 6, and 12 months postoperatively. Polyetheretherketone (Peek) cages filled with iliac bone graft were used after cervical discectomy. The levels operated upon were C 5-6 in 16 patients and C4-5 in 2 patients. Results: Marked clinical improvement as regard arm and neck pain, and NDI was observed. The pre and post operative mean and standard deviations (SD) of the various scores were as follows. VAS for pain in arm reduced from mean of 8 (SD 1.76) to mean 0.4 (SD 0.4), VAS for neck pain reduced from mean of 3.5 (SD 1.58) to mean of 0.8 (SD 0.47), and NDI from mean of 20.2 (SD 0.89) to 2.1(SD 1.05). Fusion occurred in all patients. Subjectively 79% of the patients reported marked improvement in neck pain, and 95% reported marked reduction in arm pain. Conclusion: Anterior cervical discectomy and cage fusion resulted in high fusion rate with minimal preservation of lordosis.

Context: Inter-trochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Conservative treatment with traction and prolonged immobilization lands up with many complications and often fatality. Rate of failure with internal fixation with dynamic hip screw has been found to be high, especially in osteoporotic bones. Revision osteo-synthesis is technically demanding and leads to complications. Aim: To assess the efficacy of cemented hemiarthroplasty in the management of proximal femoral fractures in elderly patients with severe osteoporosis. Settings and Design: A Case series of 50 cases. Materials and Methods: We divided these fractures into three groups and accordingly the prosthesis was used. Group 1- intact calcar and lesser trochanter non-communited-AMP type of bipolar prosthesis, Group 2- fracture of calcar - Thompson's type of bipolar prosthesis with calcar reconstruction, Group 3- group 2 + instability of postero-medial wall-modular type bipolar prosthesis with lesser trochanter and calcar reconstruction. Greater trochanter, calcar, and lesser trochanter were reconstructed with encirclage, tension band wiring, fashioned bone graft, or bone cement collar accordingly. Results: In our study of 50 cases with mean age 79.57 years, 20 cases were type 1, 19 type 2, and 11 type 3 fractures. The average Harris hip score was 79. Excellent to fair results were obtained at follow-up in 46 (92%) and in 4 (8%) results were poor. The mean Harris hip score was 83 (good) in Group- I, 79 (Fair) in Group- II, and 72 (Fair) in Group- III patients. Average hospital stay was 12.5 days. There were four cases of superficial operative site infection which were treated with short course of oral antibiotics. Four cases died of medical complications, earliest being 3 months, and latest being 18 months. No case of loosening of the prosthesis, break in the cement or sinking of prosthesis was seen.

Menopause is associated with decreased heart rate variability, which is due to reduced parasympathetic or increased sympathetic outflow to the heart. Acute myocardial infarction may be accompanied by decreased heart rate variability. The causes of autonomic dysfunction in postmenopausal women may be multi-factorial i.e., dyslipidemia, increased body fat percentage, aging and loss of female sex hormones. The cardiac vagotonic and sympatholytic effects of estrogen can explain, at least in part, why premenopausal women compared with postmenopausal women have a lower coronary heart disease incidence and mortality rate.

The emergence of Carbapenem-resistant organisms from the family Enterobacteriaceae is a major challenge in the intensive care facilities. They produce carbapenemases which inhibit carbapenems belonging to the Ambler classification group B and they depend on heavy metals like Zn ++for hydrolysis of β-lactam ring. Most of the clinically important metallo-β-lactamases (MBL) belong to five different families (IMP, VIM, SPM, GIM, and SIM). They are typically transmitted by mobile genetic elements inserted into integrons and spread through Pseudomonas spp, Acinetobacter spp. In a study from New Delhi, 36 out of 56 P. aeruginosa species were MBL positive and from Vellore MBL was detected in 20 out of 61 P. aeruginosa 20 (32%). Inappropriate antibiotic usage, defensive practices by medical practitioners, promotion of antibiotics by pharmaceutical companies are major hurdles in the direction of rational use of antibiotics. Intensified infection control strategy should be adopted to prevent emergence and spread of carbapenemase-producing organisms.